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The Good and Evil of Alcohol

"If you mean the demon drink that poisons the mind, pollutes the body, desecrates family life, and inflames sinners, then I'm against it. But if you mean the elixir of Christmas cheer, the shield against winter chill, the taxable potion that puts needed funds into public coffers to comfort little crippled children, then I'm for it. This is my position, and I will not compromise!"

- A Congressman's response about his attitude toward whiskey.

We are returned to this politician's "insight" (is that the same thing as "equivocation") by "a major new study" (French) referenced in the Telegraph (U.K.): "Moderate drinkers have lower rates of heart disease, obesity and depression than people who abstain from alcohol entirely, the report indicates." Meanwhile, a Spanish study found recently, drinkers are less likely to succumb to Alzheimer's.

Personal disclosure: I earn my living from treating alcoholism and addiction, as well as writing and lecturing about them. I have also received money from alcohol producers. I receive many times as much for the former through my Life Process Program, which is the basis for a residential treatment center - as much in a good month as I have received in the last decade from the latter. I was an adviser on substance use disorders in the American Psychiatric Association's manual, DSM-IV.

Publication disclosure: In the August issue of Addiction Research and Theory, I have a commentary entitled, "Alcohol as Evil - Temperance and Policy" and a rejoinder to comments—one from an English-speaker, the other Italian—entitled, "Civil War in Alcohol Policy: Northern vs. Southern Europe."

A brief history of alcohol in America: Americans drank between three and four times as much per capita in the Colonial period as they do today. Since then, alcohol use has ebbed and flowed in arcing cycles in the United States; a national binge at the turn of the twentieth century led to Prohibition from 1920-1933. Sociologists have analyzed Prohibition as a war between a nativistic Protestant America and an immigrant Catholic one. Cities dominated by immigrants—like New York, Boston, and Detroit—barely acknowledged Prohibition. This split, although attenuated, is still highly evident in America. Twice the percentage of residents of Northeastern states drink alcohol (although still only about two thirds) as do in Southern states such as Kentucky and Tennessee (one third).

But wait. The last two states (33 percent and 30 percent drinkers respectively) are famous whiskey-distilling and moonshine states. Ah, therein lies a story. A remarkable number of Southern counties are still "dry," requiring people to drive to neighboring counties to drink or to drink illegally produced alcohol - both of which are associated with binge drinking.

A brief international analysis of alcohol consumption: After decades of casual observations that Scandinavians and English-speakers are binge drinkers and Southern Europeans drink wine casually with meals, the European Comparative Alcohol Study (ECAS), conducted by Scandinavians, found this was true. Scandinavians, the English and Irish are frequent bingers; Greeks, the Spanish, Italians and French rarely binge. But here's the rub - not only do the latter nations have fewer alcohol-related social problems, they actually have lower death rates due to drinking, even though Southern nations, due to their steady imbibing, drink more! Remarkably, ECAS found an inverse correlation between the amount of alcohol consumed in a country and that country's rate of alcohol-related mortality.

So some people drink alcohol well and healthily; and some binge, which can result in deadly accidents and culminate in periods—perhaps lifetimes—of alcohol abuse and alcoholism.

Is alcohol good or bad? As comments on this post may indicate, people hold different opinions. For some, the deathly, disease-like traits of the substance predominate; for some, the positive, fun and even health-seeking aspects prevail.

Positive and negative attitudes towards alcohol and good and bad experiences with alcohol are related. But—oh, the paradox—the former precede and determine the latter. The Telegraph article cited above noted that, while "recent research has highlighted the health-giving properties of wine and some other alcoholic drinks, the authors of the latest study sound a note of caution."

It may not be that alcohol produces these benefits, but that people who lead good lives are moderate drinkers, not teetotalers. What does this say about what we should teach about alcohol? People with better lives have more positive views of alcohol and alcohol contributes to their lives. (Residents in my treatment program—this does not include you—you have reached a different place at this point in your lives!)

P.S. Please don't send me comments like one I listened to from an active woman alcoholic (NOT a patient): "Don't tell me that your parents teaching you how to drink prevents you from becoming alcoholic—my father took me and my sister into the basement and made us both drink until we became sick—then he said, 'See what drinking does!' And look what happened to me."

I feel she missed my point. She's an example of how conveying negative attitudes about alcohol becomes self-fulfilling. On second thought, go ahead and make such comments.

The paradox described in the blog post is one of the reasons alcoholism is so difficult for those who suffer from it. Alcoholics are surrounded by people and a society that can indulge alcohol within safe limits and thereby advance their well being. That observation, unforttunately, encourages alcoholics to think that they too can safely indulge and control their drinking. For some, that simply is not possible, leaving abstinence as the only path.
Abstinence, of course, is much more difficult when one is surrounded by folks drinking in a way that advances their health and happiness...

People go through careers of alcoholism, most usually rescuing themselves without quitting drinking, according to the NIAAA. Your description - which is true to America's fearful temperance legacy and AA's poltergeist - is wrong, unhelpful, and actually harmful:

see my blog: United States Changes Its Mind on Addiction - It's Not a Chronic Brain Disease After All

Many things AREN'T inherently evil - peanuts, for instance - but if you're allergic to them you'd better not eat them. Any responsible physician would advise you not to, and your family would probably urge you to avoid them, as well.

Many studies have shown that some people just can't drink responsibly, for biological reasons (http://stark-raving-sober.blogspot.com/search/label/Research) due to a condition called alcoholism. Perhaps you've heard of it? Obviously, if you're "allergic" to alcohol, you shouldn't drink it, and that's a responsible message for society and the medical establishment to convey.

I guess you saw the NY Times story saying people grossly overreported being allergic to peanuts - kind of a mass hysteria: "Doctors are diagnosing allergies where none exist and people are assuming that they have allergies when they do not. Many are getting caught in what Dr. Aronowitz calls 'the career of a diagnosis.'"

I Can’t Eat That. I’m Allergic.

By GINA KOLATA
Published: May 14, 2010

WHEN Robert Aronowitz sees friends he grew up with, he braces himself for their usual greeting. “Hey, Snot Nose. How are you doing?”

Yes, “Snot Nose” was his nickname then, and even now, his friends like to remind him of it.

“I was swept up twice a week from the streets of Brooklyn for allergy shots,” said Dr. Aronowitz, a professor of history and sociology of science at the University of Pennsylvania. Those shots, he said, “were just like orthopedic shoes — a source of middle-class Jewish pride.”

Did they help? Did he even have allergies? “Who knows?” Dr. Aronowitz said.

But that experience helps him understand the tendency today to blame allergies for tiredness, upset stomach, or any rash or illness.

Food allergies are real and can be life-threatening. It would be folly to dismiss them. But many people think they have them when they actually don’t, according to a new report commissioned by the National Institute of Allergy and Infectious Diseases. And that says a lot about how we think about food. [and alcohol]

I can't wait until middle school and high school health education and life management classes start to teach kids about the positive social, psychological, and physiological effects of moderate drinking for the vast majority of people.

Alcohol use like many, no perhaps most things in life, is not simple. The variables are many and there are no simple answers. Some people are born with deficits that don't allow them to control or metabolize alcohol normally. Some mistakenly use alcohol as medicine, instead of in celebration. As the author says, some binge and some use alcohol moderately. In other cases there has been poor modeling. The list can go on and on. Because alcohol causes so much damage and pain it is important to continue studying its effects.
Great article. Keep up the good work.

I can clearly see why people might overreact to the problems alcohol can cause such as addiction, health problems, behavioral problems, and relationship problems. But why does alcohol use need to be defended so vehemently? Why must research go to such great lengths to seek a benefit for the substance? Why are so many legal restrictions universally necessary (across so many different cultures)? Why is the only technical term for the effect of alcohol "intoxication" (note the word "toxic" squarely in the middle). Coffee, tea, and sodas are socially stimulating (and not really necessary) but they don't need to be defended (rationalized?) so vehemently.

1. Because it makes people drunk (not to say intoxicated);
2. Because it thus (especially in modern America) confuses us about the competing values of states of leisure mindlessness and of productivity;
3. Because it thus (especially in modern America) confuses us about the causes of and responsibility for addiction (substances? biology? personal and/or cultural outlook?).

Particularly in western culture all you have to do is look at how alcohol is being marketed to the masses. Go back to your basic social psychology structure of advertising: hot physically fit young women in bikinis drinking beer and playing golf (has anyone ever seen this phenomenon...really?) on mountain tops, Christmas card-like commercials of heavy horses pushing beer through the holiday snow in that it somehow beer alone brings about holiday cheer. Never do you see obese, old people drinking beer in commercials or those who use alcohol in binge excess to escape the holiday blues.

While there is strong evidence that drinking red wine in moderation is healthy in terms of preventing stroke and heart disease most still choose to abuse alcohol for the instantaneous cessation of the conscious pain in their lives which ironically forms health and societal problems. No brainier as to why it is so popular and addicting. It all boils down to how one uses it it, I suppose.

Liver disease affects 6% of Europe's population and alcohol is the 3rd largest cause of death in Europe ,after smoking and high blood pressure according to World Health Organisation, and, European public affairs.If we are truly honest with ourselves we should admit that most people drink alcohol to alter their state of mind e.g Most alcoholic drinks do not taste nice to the palate ,they dont smell nice to the nose ,they dehydrate and so are of no benefit for thirst .so,if they did not alter our minds in some way would the majority of us drink alcohol at all.Im sure we are aware of the mental and physical ,familial ,social,sexual,criminal ,employment etc problems that alcohol can cause.The old adage of moderation in all things would seem to be true ,but,because we are human and have a tendency to push the boundaries out,it would seem that as a society we should change our attitudes to drinking.Maybe stop advertisers from equating copious amounts of alcohol with the antics of male/female models dancing,laughing,having a good time

Depends on your idea of fun is.Drinkers that get drunk are the top of the table for violence,sexual abuses,rape,DUI,accidents at work,disrupted sleep patterns,poor decision making,filling ER units,unwanted pregnancies,STI's etc.......

There are a couple of things that I've noticed about addictions and alcohol. People who are addicts, maybe not all, are using alcohol, drugs, compulsive behaviours to cope with life. It seems that there was some traumatic event in their lives that continues to haunt them and they need to ignore it. "Be strong and push forward" and they use these addictive behaviours to do just that. But then, there's this other thing about alcohol where people or society in general just love it. They worship it. They use it to socialize with people to make events more fun, then eventually tolerable. There's also a fraternity or club associated with it. Drinkers recognize one another with their greeting of "woooooooooo". But if you don't drink you notice that these events are fun enough to yell out "wooooooooooo" and that most of society is delusional. maybe there is a generalized mental illness and alcohol helps us pretend to be people we think are. So, That's what I noticed about alcohol. Addictions are used to self medicate some form of post traumatic stress disorder, society is in love with everything that is associated with alcohol consumption which contributes to an societal addiction to alcohol.